Critique of Medical Practice - Case Study Example

CRITIQUE OF PRACTICE Critique of Practice PART I Crisis Episodic Enduring Protective Factors and Buffers Personal Illness Relapses Drug- and alcohol-dependency AA, NA Interpersonal Relationship with family Community/ Environment homelessness Friends, church 2. The HIV virus has been present in the client's body since 1987. She has been living with it for 20 years. And being an AIDS victim, she carries the burden of coping up with her medications to help improve and stabilize her condition and keep her recovery at a constant progress. The client is a 41-year-old African American who was arrested in 2006 for prostitution and possession of drugs. She was incarcerated for 17 months, after which, she voluntarily came to my agency, St. Luke's Recovery Treatment Center. She lives with her 57-year-old boyfriend who, unfortunately, is also infected with the virus. Aside from taking the responsibility of looking after her health, she has to deal with the problem of looking for a place to stay where she can effectively keep herself clean and avoid possible relapses. Her background shows that she was close to her father, who died of AIDS at the age of 68. Her mother neglected and abused her. She has sisters who all live in Tallahassee. Generally looking at the environment she grew up in, it is clear that there was not enough moral and emotional support from her family. The lack of guidance from her parents and the kind of relationship she had with them may have led her to resort to drugs and alcohol. She began drinking at the age of 12 and smoking Crack at the age of 28. The client's last visit to a treatment center was in 1996. She was able to keep clean for two and a half years before relapsing and start getting into prostitution again. Although she does not like the environment, the client feels safe living with her boyfriend. However, this uneasiness with her surrounding creates possibilities and risks of her relapsing again. Although she luckily receives help from her friends and from their church, it seems that the client needs more help than what is already given her. She claims she believes in and follows the 12-step program and attends Alcohol Anonymous and Narcotics Anonymous meetings. The client's major concerns include preventing relapses, dealing with her alcohol and drug dependency and staying in a decent house. Of these, her primary complaint is how to avoid further relapses from happening. This complaint was conveyed through a discussion, which was a slow transition from general information to more specific details. It started out with the client's narration of her present life circumstance, and it narrowed down to the things that bother her the most. The agency involved is St Luke's Recovery Treatment Center which offers several health-related services such as assessment and referrals, psychiatric services, and health care. The agency also conducts recreational activities, relapse prevention workshops, crisis intervention, and spiritual counseling and observances, and other religious services in collaboration with some organizations like Catholic Charities. The program most applicable and helpful to the client is the one offered for alcohol- and drug-dependent individuals. This program includes providing residence for the client, day treatment, outpatient, prevention and aftercare (St. Luke's Addiction Recovery Center, n.d.). The interventions include mental counseling, spiritual healing, health screening and monitoring, and crisis interventions. Since the agency focuses and aims at empowering individuals to cope with their problems and provides programs that assist clients in jumpstarting better lifestyles and personal growth, it helps a lot in dealing with the client. Except for minor problems with the schedule (insufficient time allotted for discussions), there were no other hindrances in working with the agency since they have a similar goal of making the client's situation better. After several sessions of speaking with the client and her concerns, several plans on how to manage her condition and lifestyle were devised. The goal is to slowly but surely eliminate her tendencies of relapsing through the continued regular attendance to the Alcohol Anonymous and Narcotics Anonymous meetings (which will also help her get rid of her chemical dependencies), and engagement in other social and more productive activities. This strategy will help her have a continuous and consistent recovery and this will also divert her attention from worries of being homeless. The combined effects of these plans will eventually mould into her a more positive outlook which will surely help in attaining the treatment's goal. St Luke's Recovery Treatment Center advised the client to practice a strict compliance to the requirements of the strategy while the agency monitors her improvement. 3. The circumstances happening in the client's life can highly be attributed to her familial background. The kind of relationship that she and her mother had was one that deprived her of the guidance that could have saved her from resorting to drugs and alcohol. On the other hand, the fact that her father died of AIDS poses as a contributing factor to her engagement in prostitution. These and the other experiences she has faced all contribute to the kind of life she is living now- homeless and full of fear of another relapse. The primary focus of the agency is to help her deal with her personal crisis or challenges such as keeping her from being involved in prostitution, and slowly help her resent drugs and alcohol and finally start a healthy way of living life. This, therefore, in general would be dealing with chronic medical concerns, anger management and homelessness. 4. The session with the client went well. The client was able to open up and share her problems and emotions. This helped a lot to make me understand her condition better. Starting with making the client feel comfortable about the discussion has contributed to making her realize that it's alright to ask for help and talk about her experiences and thoughts. Listening to her as she spoke and acknowledging remarks that needed appropriate responses have also helped in making the conversation more personal and substantial. Casually giving advice to the client may have made her feel that there is no bias in the remarks that I made. This has also showed that although the session involved personal issues, the discussion had an air of professionalism to assure her that everything talked about was to be kept confidential. Empathizing with the client is also helpful in making her see that sensitive cases are addressed with care and sensitivity. II. 5. 6. For the most part, the session went well since the conversation started off well. I was, somehow, able to gain the client's trust and made her feel comfortable and, eventually, made her be vocal about her concerns. The client was very cooperative as the discussion progressed. At first, I was careful not to make improper remarks that would make the client hesitant to talk about her issues. However, as the conversation continued, the acknowledgments that I made probably made her feel that this was an agency she could trust and she wanted us to help her. Although I gave some advice about trying a little harder, I wish I could have said something a little more imposing and elaborate. I believe that with the results that I got, the techniques that I used during the session were appropriate and effective. 7. The most common and obvious ethical issues that cases like this might suggest includes confidentiality, sexual harassment, privacy, and informed consent. Confidentiality might arise from the disclosure of supposed to be classified information. This may mean certain personal information about the client or any related data. Any information shared by the client should not be divulged without the client's consent (NASWD, n.d.). Another ethical issue would be sexual harassment. The client's background could be enough drive for someone to take sexual advantage of him or her. It should be clear, however, a client's personal crisis does not warrant anyone the right to abuse him/her in any way. In addition to confidentially, a client's right to privacy should also be recognized and respected. Respect does not only mean not divulging confidential information but also respecting a client's right to keep silent and be cautious of some personal information. III. Annually, alcohol causes 1.8 million or 3.2% of all deaths and accounts for 4.0% of disease burden (WHO, 2007). The latter figure alone suggests that alcohol not only affects the brain and causes instability in a person's thinking, but also contributes to the possible onset or worsening of diseases; it does not only cause injury, but may aggravate already existing medical conditions. Alcohol is oftentimes used as an excuse or as an agent to cope with certain problems. This may include depression, anxiety, obsessive-compulsive disorder, and schizophrenia. According to (IAS), alcohol problems occur to those who have histories of child abuse or those with Anti-social personality disorder (ASPD). It is said that people with ASPD has 21% more risk of developing alcohol-dependency problems. Clearly, too much alcohol changes people. But what is too much According to the Dietary Guidelines, alcohol affects men differently than women. To be considered as moderate drinking, there should not more than one drink a day for women and two drinks for men. The same source states that too much drinking for women can increase the risk of having motor vehicle accidents or crashes, high blood pressure, stroke, violence, suicide and certain types of cancer (NIAAA). Putting up with the ill effects of alcohol dependency is difficult. So before anything worse happens, it is important to exert effort in trying to stop and deal with one's alcohol intake. To take more control of the use of alcohol, the Keele University Counseling Service gave out some tips. The suggestions listed on the leaflets is something the client can easily follow: make a list of the advantages and drawbacks of alcohol, keep a diary of consumption over a week, talk to someone, look for a possible alternative (something with less effects), consider the social pressures to consume, consider what emotions trigger the intake, try a month of abstinence. An alternative solution to the problem would be resorting to a more scientific approach such as using relapse prevention, which is based on cognitive-behavioral principles and makes use of developed self-control strategies (Carroll, 1991). The above findings give out enough evidence to relate the client's alcohol dependency to her life's situation. She may be depressed over her illness (AIDS), and the fear of being homeless arouses her emotion more. These things are enough to bring her to the comfort of alcohol. However, because of the unfortunate event that alcohol only makes her mental state worse should give her the initiative to stop. If she doesn't, her recovery over the HIV virus will have less progress and soon, she will be more depressed which could drive her to depend even more on alcohol or drugs. The client made a wise move in asking for help. The treatment programs available to her will assist her in starting a life anew. If she continues to attend crisis intervention and relapse prevention workshops, she will be able to fully recover in time. WORKS CITED Carroll, K. et. al. (1991). Relapse prevention strategies for the treatment of cocaine abuse. American Journal of Drug and Alcohol Abuse. Retrieved from http://findarticles.com/ p/articles/mi_m0978/is_n3_v17/ai_11249653/pg_1 on October 9, 2007 Centers for Disease Control and Prevention (n.d.) Conference Proceedings on Alcohol- and Drug-Related Injuries. Retrieved from http://www.cdc.gov/ncipc/Spotlight/2003 _Alcohol_ Conference_Proceedings.htm on October 4, 2007 Keele University Counseling Service (n.d.) Dealing with Alcohol and Drug Problems (leaflet). Retrieved from http://www.keele.ac.uk/depts/aa/studentsupport/counselling/pdfs/ alcohol.pdf on October 4, 2007 NIAAA (n.d.) Alcohol: A Women's Health Issue. Retrieved from http://pubs.niaaa.nih.gov/publications/brochurewomen/women.htm#problem on October 4, 2007 National Association of Social Workers (2007). Code of Ethics. Retrieved from http://www.naswdc.org/pubs/code/code.asp on October 3, 2007 St. Luke's Addiction Recovery Center (n.d.). St. Luke's Addiction Recovery Center (leaflet). World Health Organization (2007). Alcohol and Injury in Emergency Departments. Retrieved from http://www.who.int/substance_abuse/publications/alcohol_injury_summary.pdf on October 4, 2007 Read More